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BACKGROUND: Inflammation is a hallmark of cancer and is involved in tumour growth and dissemination. However, the hallmarks of cancer are also the hallmarks of wound healing, and modulating the wound inflammatory response and immune contexture in relation to cancer surgery may represent effective targets of therapies.Repurposing anti-inflammatory drugs in a cancer setting has gained increasing interest in recent years. Interestingly, the known and thoroughly tested antifibrinolytic drug tranexamic acid reduces the risk of bleeding, but it is also suggested to play important roles in anti-inflammatory pathways, improving wound healing and affecting anti-carcinogenic mechanisms.As a novel approach, we will conduct a randomised controlled trial using perioperative treatment with tranexamic acid, aiming to prevent early relapses by >10% for patients with melanoma.
METHODS: Design: investigator-initiated parallel, two-arm, randomised, blinded, Danish multicentre superiority trial.
METHODS: ≥T2 b melanoma and eligible for sentinel lymph node biopsy (n=1204).Project drug: tranexamic acid or placebo.
METHODS: before surgery (intravenous 15 mg/kg) and daily (peroral 1000 mg x 3) through postoperative day 4.
METHODS: relapse within 2 years after surgery.Primary analysis: risk difference between the treatment arms (χ2 test).
RESULTS: postoperative complications, adverse events and survival.Inclusion period: summer 2023 to summer 2026.
BACKGROUND: The trial will be initiated during the summer of 2023 and is approved by the National Committee on Health Research Ethics, the Danish Medicine Agency, and registered under the Data Protection Act. The study will be conducted in accordance with the principles of the Declaration of Helsinki and Good Clinical Practice. Patients included in the study will adhere to normal Danish treatment protocols and standards of care, and we expect only mild and temporary side effects. Positive and negative results will be published in peer-reviewed journals, with authorships adhering to the Vancouver rules.
BACKGROUND: NCT05899465; ClinicalTrials.gov Identifier.

Pachyonychia congenita is a rare genetic disorder characterized by hypertrophic nail plates, hyperkeratotic nail beds, and thickened hyponychium of the fingers and toes, impairing manual dexterity and resulting in poor aesthetics. The current body of literature describes various treatment modalities, but no singular approach has been defined as the gold standard. In this case, the authors employed different surgical techniques for treating pachyonychia congenita to evaluate the most effective approach. A 3-year-old boy presented with hypertrophic nail growth involving all digits of both hands and feet. Three surgical procedures were performed on the patient\'s fingers and toes using germinal matrix excision (GME) alone, GME plus partial sterile matrix excision (pSME), or GME plus complete sterile matrix excision (cSME). The digits treated with GME + cSME exhibited no recurrence of nail growth. Those treated with GME alone exhibited recurrence of hypertrophic nail growth, although their growth slowed. Excision of GME + cSME prevented recurrence of hypertrophic nails, while GME alone or with pSME led to slower-growing hypertrophic nails. Complete excision of the germinal and sterile matrices with skin graft closure may be a definitive treatment for pachyonychia congenita, but further studies are needed to validate these findings.

To summarise evidence on the effectiveness of Platelet-Rich Plasma (PRP) gel and Leucocyte and Platelet Rich Fibrin (L-PRF) gel as agents promoting ulcer healing compared with the standard wound dressing techniques alone.
Systematic review.
Individual patient randomised controlled trials on skin ulcers of all types excluding traumatic lesions.Intervention group: treatment with topical application of L-PRF gel or PRP gel to the wound surface.
treatment with standard skin ulcer care using normal saline, normgel or hydrogel dressings.
Medline (Ovid), Excerpta Medica Database (EMBASE), Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Web of Science and manual search of studies from previous systematic reviews and meta-analyses. The papers published from 1946 to 2022 with no restriction on geography and language were included. The last date of the search was performed on 29 August 2022.
Independent reviewers identified eligible studies, extracted data, assessed risk of bias using V.2 of the Cochrane risk-of-bias tool for randomised trials tool and assessed certainty of evidence by using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.
Time to complete healing, proportion healed at a given time and rate of healing.
Seven studies met the inclusion criteria, five using PRP gel and two using L-PRF gel. One study showed a better proportion of complete healing, three reported reduced meantime to complete healing and five showed improved rate of healing per unit of time in the intervention group. The risk of bias was high across all studies with one exception and the GRADE showed very low certainty of evidence.
The findings show potential for better outcomes in the intervention; however, the evidence remains inconclusive highlighting a large research gap in ulcer treatment and warrant better-designed clinical trials.
CRD42022352418.

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UNASSIGNED: Accurately staging and prognosticating melanoma classically depends on a sentinel lymph node biopsy (SLNB). The mainstay predictors of SLNB positivity according to the American Joint Committee on Cancer (AJCC) are Breslow depth and ulceration. Nevertheless, even with these predictors, negative SLNBs, even in deep melanomas, are a common occurrence and may result in unnecessary invasive procedures for patients. This suggests that the parameters for determining SLNB candidates are a potential area for improvement in surgical dermatology (surgical oncology and plastic surgery).
UNASSIGNED: The authors conducted a systemic review to assess current AJCC guidelines on when a SLNB in melanoma is indicated. We also investigated how age, mitotic rate, lymphovascular invasion, satellitosis, melanoma subtype, anatomical location, and an immunocompromised state affected positivity rates in sentinel lymph node biopsies in melanoma.
UNASSIGNED: These variables significantly impacted SLNB positivity rates and serve as evidence to support the proposal of redesigning SLNB guidelines in melanoma.
UNASSIGNED: Integrating the current AJCC guidelines with the newly examined variables will create patient-specific recommendations centered on the aim of reducing the number of invasive procedures while increasing SLNB positivity rates and prognostication.

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